Chinese Journal of Pediatric Surgery | 2019
Thoracoscopic repair of recurrent tracheoesophageal fistula after operation for esophageal atresia: a report of 18 cases
Abstract
Objective \nTo explore the feasibility, surgical experience and efficacy of thoracoscopic repair of recurrent tracheoesophageal fistula (rTEF) after operation for esophageal atresia. \n \n \nMethods \nFrom October 2017 to October 2018, a total of 18 rTEF children underwent 3-Trocar thoracoscopy and their clinical data were retrospectively analyzed. All of them were diagnosed postnatally as esophageal atresia (type Ⅲ). There were 7 boys and 11 girls with a preoperative average body weight of 6.4(4.3-12.0) kg. Thoracic esophageal anastomosis (n=9) and thoracoscopic anastomosis (n=9) were performed. Seventeen rTEF children were initially diagnosed at an average age of 26.2 (10.4-79.6) weeks. After separating trachea-esophageal space and fistula, esophagus and trachea were sutured separately. Tracheal fistula was wrapped with a pleural patch and a thoracic drainage tube finally inserted. \n \n \nResults \nThe average operative duration was (3.3±1.4)(1.5-7.5) hours. For two cases of postoperative esophageal leakage, one died of severe infection and another had a recurrence of tracheal esophageal fistula. The average hospitalization length was (15.6±5.6)(11-23) days. After a follow-up period of 1 month to 1 year, 14/16 children resumed oral intake while another 2 cases required nasogastric feeding due to right vocal cord dysfunction and eye infection after right glaucoma operation respectively. Except for one death, the average body weight was 9.4(6.0-16.5) kg during follow-ups. \n \n \nConclusions \nWith skilled thoracoscopic techniques and an experienced nursing team, thoracoscopy is both safe and efficacious for repairing rTEF. \n \n \nKey words: \nThoracoscopy;\xa0Esophageal atresia;\xa0Tracheoesophageal fistula;\xa0Recurrence